S-5089-119
Read twice and referred to the Committee on Finance.
Sponsored by Angela Alsobrooks (D-MD)
What it does
The bill would add dental and oral health services (exams, cleanings, x-rays, fillings, extractions, root canals, crowns, dentures, and emergency care) to Medicare Part B for services furnished on or after January 1, 2028. It would repeal the current Medicare exclusion of most dental care. Routine exams, cleanings, and x-rays would be covered as preventive services. Payment for other dental services would start at 0 percent of the allowed amount and rise 10 percentage points a year to 80 percent, while certain low-income beneficiaries would get 80 percent from the start. Dental prostheses would be covered on a similar phase-in, limited to one set per 5 years. The Secretary of Health and Human Services may add limits such as prior authorization, modify coverage consistent with U.S. Preventive Services Task Force recommendations, or waive frequency limits. The bill would also set the federal share at 100 percent of state Medicaid costs for dental cost-sharing for Qualified Medicare Beneficiaries, and would require at least one oral health professional on the Preventive Services Task Force.
Who benefits
Medicare beneficiaries, who number roughly 65 million and many of whom lack dental coverage today, especially those needing dentures, extractions, or major work. Low-income beneficiaries eligible for Part D subsidies, who would receive 80 percent coverage immediately. Dentists and dental practices, which would gain a new payer. State Medicaid programs, which would receive a 100 percent federal match for dental cost-sharing for Qualified Medicare Beneficiaries. Hospital emergency departments, which may see fewer dental-related visits.
Who is hurt
Federal taxpayers, who would fund new Medicare spending; the bill contains no offsets. Part B enrollees, who may face higher premiums and deductibles because Part B premiums are tied to program costs. Dental practices, which may face Medicare payment rates below private rates, prior authorization, and administrative burden. Beneficiaries with major dental needs, who would pay most costs during the early phase-in years. Medicare Advantage insurers that currently offer dental as a competitive benefit, which may see that advantage reduced. The Medicare program itself, which may face dentist-supply limits and implementation costs.
Supporters argue
Supporters argue that traditional Medicare excludes most dental care even though poor oral health is linked to heart disease, diabetes, and avoidable emergency visits. They contend that roughly half of beneficiaries have no dental coverage, according to KFF analyses, and that a phased-in payment schedule with immediate 80 percent coverage for low-income enrollees targets help where cost barriers are greatest while giving providers time to prepare.
Opponents argue
Opponents argue that adding a broad new benefit would raise federal spending significantly without offsets, and would push up Part B premiums for all enrollees while Medicare's trust funds already face solvency pressure. They contend that wide Secretary discretion over scope and limits creates uncertainty, and that Medicare payment rates and administrative requirements may discourage dentists from participating, limiting real access.
Constitutional context
Congress creates this benefit under the Taxing and Spending Clause (Art. I, §8, cl. 1), a power broadly upheld for Medicare. The Medicaid match change is a voluntary federal funding increase to states, so it raises no coercion concern of the kind found in NFIB v. Sebelius (2012). The bill raises no other significant constitutional question.
Checks and balances
Congress expands the Medicare benefit and delegates significant discretion to the HHS Secretary to define services, add limits, and waive rules, with oversight through appropriations, committee review, and judicial review of agency interpretations.
Historical precedent
Medicare has excluded most routine dental care since its creation in 1965, and earlier proposals to add dental benefits, including provisions in the 2021 Build Back Better Act House bill, were not enacted.